The fastest discharge in the history of the world

I wasn't too busy, so when my friend Emily called and asked me to come to the ward to check on our friend Lawrence I went right away. It helped to hurry my pace that she said something about "anesthetic" or "pain." Since Lawrence had been admitted after being hit bar a car 10 days ago, he had had plenty of pain--mostly related to significant soft tissue injury to his right arm that had been requiring daily dressing changes. In any first-world hospital he would have had proper pain control in accordance with his weight, his status as a child/teenager, and the severity of his injury. He also would have had proper dressings that wouldn't stick to the wound and rip it open afresh every day.

Instead, because he was in Uganda, in a hospital that didn't even have enough gloves to complete the dressing changes, he got various forms of pain meds depending on what the nurses could find--nothing was usually documented because there is usually one nurse for 20 patients and they are just too darn busy to document--and sometimes without much regard for whatever the doctor had bothered to write. Of course, in the hypothetical first-world hospital, he would also have been sacked with a bill probably over $10,000.00 for a stay of 10 days that included one trip to the theater (OR). Or rather, he wouldn't ahve been treated at all, since he is a street kid.

Over the duration of Lawrence's hospitalization I had bothered the nurses and clinicians quite a bit with questions about medications, dressings, care-plans, protocols, etc etc etc. However, when I came onto the floor on this particular day, a group of men I didn't recognize were gathered a short distance from Lawrence's bed, and Emily was standing protectively next to Lawrence--who looked like he was about to bolt at any time. Emily explained that one of the men had come over and started to remove the dressing as Lawrence slept--no warning, no pain meds. I did not blame Lawrence for looking ready to run.

"Have you brought it?" The leader of the white-coated men asked me. I was confused. What was I supposed to bring? Apparently he didn't know either. I'm guessing it was some sort of pain med, since he didn't seem to have any. My anger that had been building over the last ten days finally spilled over onto this nameless character. I looked him square in the face, and said "WHAT is your PLAN?" "Plan?" He answered, puzzled. "YES, your PLAN? PLEASE don't tell me you were planning to remove this dressing without pain meds." "It isn't about the pain," he retorted.

At this point I had had enough. "IT ISN"T ABOUT THE PAIN FOR YOU, BECAUSE YOU HAVE ALL YOUR SKIN STILL ON YOUR ARM. When was the LAST time he had any medicine?"

"What?" Mr. white coat was not getting me. I repeated the question, my face inches from his (really--i wonder--where do i get the nerve to speak to people like this? I really have no idea) I repeated the question again and again..to all the members of the group, to the nurse on duty. I sounded like a broken record. I was probably stamping my foot. Truly, for someone who took so long to develop documentation skills and who routinely called her workplace after midnight to ask people to document meds that she had forgotten to note...I was being a bit over the top. Maybe. At some point Mr. White coat asked me, "DO you have a medical background? Are you related to this patient?" I straightened up, raised my voice, and said, "I am a NURSE." YES. I don't think he was impressed, but I felt good.

At this auspicious moment my phone rang. My friend Glenda, who has a high-level job and connections in the city, and to whom I had poured out my frustrations with the hospital the previous day, had come up with a connection at IHK (internation hospital of kampala) where Lawrence might be able to get free (and much better) care.

With only the hint of a promise of a solution in my hand, I walked up to the group of doctors. They informed me that they would be taking lawrence to the theater to put him under general anesthesia for his dressing change. (THIS IS A SOLUTION? GENERAL ANESTHESIA?). I calmly informed them that they only place lawrence would be going was out the door, with me, and I kindly (!) asked for his discharge papers. They blinked once, twice, and filled out the paperwork within five minutes. Emily and I ran around collecting cash for the bill (in this blessed country, until you pay your hospital bill you are a prisoner of the hospital, unable to leave the grounds), paid it, and left. At some point in this frenzy of activity I remembered to ask Lawrence if he wanted to leave. His answer was to painfully hobble over to the door and ask for some sunshine. His grin was unstoppable. I knew we were doing the right thing.

We had to round up a taxi (the private kind, not the fifty-people in a fifteenpassenger van kind)and over bumpy roads, with lawrence gritting his teeth the whole way, we made our way to IHK.

Although he still had pain when the dressing was removed at IHK, the fact that he bounced up from the table at the end of the ordeal and began shaking all the nurses' hands and thanking them for helping him...this witnessed to his changed situation. I felt the entire time as though we were in some sort of medical heaven. The nurses had gloves! Saline! Dressings! At no point did they ask me to go look for or buy supplies. At no point did they refer to lawrence as "difficult" or "stubborn."

I want you to know that the medical care at IHK for everyone else who walks through those doors is extraordinarily expensive--more like western medical costs. So it still begs to be asked--is our system really that much better than what I encountered through Lawrence's hospitalization? If we have endless supplies, endless specialists, the very best in pain control...but if these are only available to the wealthy, or well insured, or if a major accident or illness leaves a family bankrupt and destitute as a result of inflated costs..is the system really that much more just? I think not. And as a side note, the problem of arrogant medical professionals does not just exist on this side of the globe. Although I was just a friend to Lawrence, being on this side of the conversation in a hospital is daunting and demeaning. I cannot imagine how dehumanizing it can sometimes be for patients who see themselves at the mercy of the all-powerful white coat.

The end of the story is good (for Lawrence)..he will most likely regain full use of his arm. He is happy to be back in the garage where he lives with 11 other street kids, and when I last saw him yesterday evening he was practicing his trumpet with one good arm and asking intreguing questions about white blood cells and the immune system.

For the rest of this country, I'm not so sure. What does justice in medical care mean? Is there a road between shoddy but affordable (for some people) care, and high-quality but unaffordable care? Do we all deserve compassiate nurses and knowledgable doctors? What would it take to transform the hospital that I work in to a place where adequate care was given and recieved? I don't know...

Food for thought.

Andy

Andy showed up to Monday clinic yesterday. As many do, he has waited until he is very, very sick to come for testing and care. In triage, I find his BP is 76/50, heart rate 130, temp 39C (axillary) and weight at 48 kg (for a man who is about 5’10”). He walks only with assistance, and is so shaky I cannot trust him to make his way to the doctor’s room alone.

Later, another nurse gave him an injection of gentamycin and sent him home with an IV drip (luckily our clinic driver was around and took him home in the truck) that would hopefully rehydrate him a bit. We planned to visit him today on homecare.

Andy is staying in a house his uncle is helping to rebuild/refinish. As is common, his uncle is allowed to “squat” in the home while they are working on it. The house is un-adorned cement, windows and doors gaping holes to the world of wind, rain, and insects. We find Andy awake, on the porch slumped in a wicker chair. He is shaking, with the tremors in his left hand getting worse. The cannula that we left in the right hand is still there, but is open and dripping blood occasionally. The other nurse caps it off. I shudder.

Andy is kind of staring, kind of wide-eyed, and I wonder how mentally savvy he is right now. Because my Luganda is not up to a mini mental exam-caliber, I trust the others when they say he is “ok”. I try his blood pressure (80/60), his temp (still around 39C), and his heart-rate (about 140). In these situations I can never help but think what I might do if I was back at Dartmouth. Something, anyway. Our clinical officer opts for another two liters of IV fluid (we are out of normal saline these days, until the drug order comes in, so a combo of D5 and LR will have to do the trick). Another few antibiotics. The other nurse and Andy’s uncle help Andy out of his wicker chair, and half-carry him, half-lead him through the very empty shell of a house to a back room, where there is a well-worn mattress on the bare-cement floor, and a chair holding andy’s medications. The drip from yesterday is hanging from a nail on the wall (uncapped). Christine discards it and hangs the new drip. Explains the medications. I stand around, mute. The barren-ness is awful. Although I realize that it is great that Andy’s uncle even has a roof and a mattress to offer him, I can’t imagine that this very chilly room with a mattress on the bare floor is at all a place of rest. I pray for Andy. We are about to leave, when Francis suggests I give him some food out of our supply in the back of the truck.

Food, I’m told, is not a sustainable program. This, I realize. Nor is it fair for me to “shower” our clients with food while I’m here, and then leave the clinic staff to answer for the absence of food after I am gone.

I realize that it may be very, very selfish of me to insist that we bring food on our visits (and by the way, I am so thankful on behalf of the clients for those of you who are helping them in this way). I realize that it may be my very American/western character that wants to “hand something out,” instead of just walking away and trying to forget it all until I come the next week and enter into the private hell of Andy, or any of our other clients.

I suppose it goes with the territory, of working here. We (Americans) have a history of walking into desperate situations and trying to throw a quick solution on it, money, candy, whatever. This is one of the reasons I wanted to work with MCC—it has a history of a being a relief and development organization that emphasizes being in relationship with your community—focusing on the relationship as being the lasting impact, and the vehicle by which one can accurately assess the needs of the community and the offer assistance as a friend, rather than as a “benefactor” or “donor” or “rich white stranger that will never come again.”

Still, though, sometimes I really want to forget about sustainability and relationship (should I try to befriend Andy before I give him food? Would that make it a ‘better’ solution? In reality this is not possible- he is sick and hungry now!) and just staunch the flow of blood, if you will, so that the individual will live long enough to benefit from a “sustainable” solution to their problems.

It really doesn’t help the guy to have a fishing pole, if he is too hungry to learn how to use it.

Anyway, the end of the story is that Andy didn’t get better, he is now (as far as I know) admitted to the government hospital (from which he will be lucky if he comes out alive). I have no idea if the food we gave him helped that day, or for two days, or not at all. Do you see how it can be a bit discouraging and confusing, to know how to proceed in these situations? The jargon of development doesn’t give me much help. I pray for discernment, and for wisdom. And for healing for Andy.

Peace.

Our "new" clinic in progress (demolition still)--pray for safety for the builders (and that they be honest and eficient in their work!)

Anna, of a previous blog, modeling her new sportswear.

This is one of our kids at children's club. He is sporting the lovely sunglasses my mom brought when she came!

Traveling From Masindi to Gulu with my mom and Aunt (In March, I'm catching up, sorry)

It was like a road trip,in a way, but without the fun stops at Dunkin Donuts for iced-blueberry coffee. And without the comfortable family-sized air-conditioned vehicle. Oh, also without traffic rules or the requisite road trip music you can sing along to.
It was with great fear and trepidation that I even considered bringing my mom and aunt on public transport to the northern part of the country. Not because they are old—oh no, they are as young and spry as they come. Just because traveling in Uganda can push you to the very limits of sanity, the very edge of reason, the extreme, farthest-out reaches of your strength and energy. In short, it can bring you to your knees, weeping, begging for mercy (or for your mama).
We boarded the bus to Gulu, or rather, tried to board the bus to Gulu, but there wasn’t a bus going to Gulu. There was a bus going to Bweyale. I nodded knowingly as the driver told me this, and confidently lead my mom and aunt to the very back of the bus he indicated. They asked me where Bweyale was, and I had to confess that I had no idea—no map, no clue. I was just hoping it was actually North, in the general direction we wanted to go. (This reminds me of a talk I heard at Dartmouth last year, by Wangari Mathai (spelling? she won a nobel peace prize for her work in the environment, pretty cool lady)--she told as story about traveling in Africa, and how somtimes you realize you are going the exact wrong direction and just need to GET OFF. I've wondered if I would have the courage to get off? In the middle of the bush? Would that be a good idea? Luckily, friends, it hasn't happened --yet--)
The bus was almost full, so it seemed possible that we might leave in a reasonable amount of time. Meanwhile my mom kept looking behind her at a wide gap behind her. “Do you think they can close it?” She was worried. I studied the construction of the bus carefully, craning my neck around and finally saw a stick propping open what seemed to be a door. “don’t worry, we’ll be fine,” I said as someone began to cram huge bunches of bananas under our butts. “Ooh!” My aunt exclaimed. Sitting on bananas for a few hours could be interesting. The rows in front of us began to fill, and the efficient (read: greedy) conductor began instructing all the rows in front of us to sit five across. For some reason he didn’t ask this of us, which became a source of animosity as every single person boarding looked at us and said in Luganda “Why don’t the WHITE people have to sit five across?” Yeah, I felt good.
We eventually started moving—went about five feet and then stopped again to load something on top of the bus. Five more feet- took something off the bus. Six feet. A bag of charcoal on top. Four feet. The driver stopped to chat with his friend. Thirty feet (we started getting excited)—three guys jump off, run around for awhile, and three different guys get on.
It took awhile to reach Bweyale.
We eventually did- (luckily, for me, it was generally in the right direction)—upon getting out of the bus in the dusty street, we were inundated with offers for assistance. “GOING WHERE?” “WHERE GOING?” “COME HERE,MAZUNGU.” “WE GO?” I tried asking a few people where the bus for Gulu was (hoping that it did exist). I got a few different answers, several people assuring me that everyone else was just “disturbing” me, but finally found someone else who was going and said the bus was coming, in fact, would be leaving very soon.
Someone dragged up a few benches for my mom and aunt and insisted that they sit down. As soon as I got the bright idea to ask about tea though, our new friend told us to “Come quickly!” We indeed came quickly, to find the (van) empty except for, now, the four of us.
There began an hour of waiting—wishing—hoping—praying—as the hot afternoon got hotter, and the dusty town got dustier. I could tell that a few of the people standing around were also going with us, but it seemed an eternity before some secret signal was given an everyone ran for the van, piled in, and we took off.
For two feet. A woman with two chickens got in. Another ten feet. A bag of charcoal. Five feet. Someone took the bag of charcoal off. Half a kilometer. Six more people get in. My mom and aunt started voicing their frustration. “Why are we stopping?” “We’re stopping again?” “What are they DOING?”
At this point I began to seriously worry that I was doing irreparable damage to my relationship with my mom and aunt—would they ever forgive me for exposing them to such a torturous experience?
We proceeded to stop approximately ever five kilometers on the 120 kilometer trip up to Gulu. When we finally reached the fair town of Gulu, and disembarked that accursed vehicle, I was told in no uncertain terms that we would not be attempting any other forms of public transportation for at least 48 hours.
I wish I could say that was the end of our misadventures on public transport, but you’ll have to ask Aunt Carol about her experience sitting next to the Large Man with a poor understanding of personal space (and how she defended herself with well-placed jabs to the ribs.) Or how they both enjoyed riding three- to a motorcycle through bumper to bumper traffic at night in Kampala. Or how nice a private-hire taxi felt when their cheapskate niece/daughter finally was willing to shell out four dollars for a little comfort and safety!
Another time, though. Another time.

Life came over the wall

I was washing dishes this morning after a particularly nice breakfast at Gann and Dale's house. I lazily took note of the tan trousers hanging from the razor wire on the back wall of the house, and alerted my co-dishwasher Eric to their presence. "They look like mine," he noticed and Gann asked if he had hung any clothes on the line that could have been his--the answer was no.

Twenty minutes later Eric came running in from the "boys quarters" (a colonialism term referring to separate housing behind the main house for the "help;" Gann and Dale use these rooms for extra guests.) "They are my shorts, I was robbed!"

Apparently someone managed to enter his room as he was sleeping last night, took his backpack that had his phone and all his money, as well as an ATM card and other various "essentials" to life here. We kind of stared at each other in shock--never once had I ever felt unsafe in this house; although Dale and Gann are very careful with their locks on the gate and on the house, and although they have a large, ferocious dog, they do not keep a night guard. All the necessary activities after this sort of event were efficiently carried out by Dale and Eric (unfortunitely keeping us from palm sunday service at church): reports filed, local council and neighbors notified, police notified.

We catalogued the graces involved in this incident--his MP3 player was inside the main house(music, for us and our interminable rides on public transports and frequent bouts of stress or noise-related insomnia is essential to sanity), he did not wake up while the intruder was inside, and (later, we discovered) his backpack and everything but the phone and money was found on the other side of the wall, abandoned.

I have always felt an insular-kind of safety here, where we come for meetings or "retreating." Although right outside the wall is normal life as I know it in Kampala--yelling children, motorcycles, leering men, etc--inside the wall is quiet, peaceful, safe. I am in a womb, a cocoon, and am able to relax.

Is the wall around the house keeping out Uganda? Did the vulnerability I felt, thinking about the intruder relate to an unconcious perception of Uganda as "the other," "the enemy," or even just "the problem?"

Because MCC has such a strong emphasis on our ministry of presence and life-sharing in our communities, it occurs to me that this response might signal some spiritual pathology on my part. It is different from the vulnerability I felt last fall after almost being mugged--I was on the street, after dark, in a dangerous area--and someone chose to take advantage of my carelessness.

My question more relates to walls in general. Someone came over the wall. Moreover, they came over the wall, and into Eric's room. Why is it that I need this wall in order to relax, that here--away from Uganda, on a small bit of ground I realize I think of as 'apart' or 'separate'? Why is it that the incursion of my life outside--the life that is callous and antagonistic, into this place shakes me so much?

What is it about this world that I want to keep out with a wall? Do I have walls in my life at "home" (ie, US, Vermont, Norwich, Barn) outside of which I am pressing to keep "life" on some level--the life that has people who are willing to jump over razor wire to get money for their children's school fees, or food, or medical bills, or whatever? Why do I perceive the rest of my life as something to be overcome, or something that I have to fight against--and why is it disturbing that this life penetrated the cocoon of my rest?

Dear friends, I have no answers (nor am I sure that I have made any sense at all) but I put these questions into the great void of blog-dom, the large expanse of the internet conciousness hoping that they will return to me less than void.